Vipul Gupta watched his 33-year-old brother die of a malignant tumour in the brain eight years ago. “We knew it was hopeless but we went all the way. He was operated on thrice, at the All India Institute of Medical Sciences in India and Cleveland Clinic in Ohio and Memorial Sloan-Kettering Cancer Center in New York. That’s when I realised that even when the chips are down, the family does not give up, so you have to give it your best,” says the Delhi-based Gupta. He’s a little embarrassed about the emotional outpouring. “Surgeons can’t be emotional, it won’t help the patient on the table. You have to be calm and think clearly,” he says. At 41, Gupta heads neuro-intervention at Medanta – the Medicity, where he moved after doing his MBBS from Delhi’s Maulana Azad Medial College in 1996 and training in neuro-radiology at All India Institute of Medical Sciences (AIIMS) for three years. “I’m out-doorsy and enjoy swimming, rafting and rock-climbing. I broke my knees twice in school. The operation and forced bed-rest for six months slowed me down, forcing me to study which helped me crack the MBBS easily,” he laughs.

Dr Deepak Agrawal, 40, Associate professor, Neurosurgery, AIIMS
He’s the guy at the frontier, treating accident victims at the AIIMS Trauma Centre, best known for treating some of the bloodiest and most bizarre accident cases in the country. “Most accident victims we get are people with severe head or spinal injuries that are often fatal. It does get you down, but nothing can beat the high of seeing a patient everyone including your colleagues had given up on, walk into your clinic for a follow-up. That’s when you know that miracles do happen,” says Dr Agrawal. Agrawal did his MBBS at the University College of Medical Science in 1994 – where he met his onco-surgeon wife Swati – and his training in neurosurgery at AIIMS. “My professional high was being awarded the ‘Young Neurosurgeon of the Year’ Award by the American Congress of Neurosurgeons in 2008. The personal one was my daughter Ayushi, who is five,” he says. His father Dr Ved Prakash was also a neurosurgeon at AIIMS, so Agrawal’s becoming a surgeon was almost pre-determined. “I like to catch up on my emails before breakfast, so I begin work at 5.30 am. I leave home at 7.30, doing rounds of the ward for three hours, which is followed by surgeries that usually go on till 7. Then come the evening rounds, which finish at 9 pm. Add to this administrative work, teaching and writing and correcting research papers, and my day never seems to end,” says Agrawal.

Bangalore residents are used to seeing Dr Sri Ganesh zooming down the streets to his farm on his Suzuki Intruder, which he exchanges for his Audi Q7 or BMW 5-Series when he visits the hospitals he set up. “Both my grandmas were blinded with cataract, one because of a botched up surgery. I think seeing them faltering around the house made me decide I wanted to do all I could to help people see,” says the 44-year-old. Eye surgery techniques have become much safer now. “Back then, there were no intraocular lenses (artificial lenses put inside the eye in place of the natural ones) and the failure rate of a simple cataract surgery was 30 per cent, largely due to infection. Now, less than 0.1 per cent cataract and vision-correction surgeries have complications,” he says. Sri Ganesh met his wife Sumanshree at a paratrooping camp in Agra. He was 17, she was 16. “Someone stole my things and she was very sweet,” he says. They married six years later, in 1990, after Sri Ganesh did his MBBS. The couple have three children, Supriya, Sushant and Skanda. Apart from running six hospitals – four in Bangalore, one in Mysore and one in Mangalore – Sri Ganesh runs a 90-bedded charitable hospital in Padmanabhanagar that does 8,000 free cataract surgeries a year.

Dr Mahipal S Sachdev, 52, Centre for Sight Group of Hospitals

Mahipal S Sachdev, eye surgeon to the rich and powerful, never invests in anything but health. “My last investment was Harshad Mehta and I burnt my fingers there,” says Dr Sachdev. His investments in healthcare – time, energy and money – have shown better results. Sachdev was told he was crazy when he quit as associate professor at the All India Institute of Medical Sciences (AIIMS) to join the newly-opened Indraprastha Apollo Hospital in Delhi in 1996. He was 37. The skeptics got it very, very wrong. Within 15 years of that, he’s running 17 eye hospitals that have become one-stop shops for eye disorders in north India. A year-long fellowship to Georgetown University in Washington DC in ’89-’90 opened his eyes, literally, to the technological imaging and surgical revolution happening in the field of ophthalmology. “I realised less invasive radical surgeries were the way forward, but I needed equipment and trained staff for that. I could not get that in a government set-up. So I set up my own centre, which started in a 8×10 foot room in Safdarjang Enclave in 1996, but we’ve grown a little since then,” he says with obvious pride. Sachdev is arguably the best person to go to for cataract and lasik surgery in India. “This is all I want to do, medicine is in my genes. My mother and brother are doctors, so is my wife Alka and daughters Ritika, 29, and Gitansha, 25,” says Sachdev. Sachdev also has an unexplored, fun side to him. “I did my MBBS from AIIMS, where I was the secretary of the students’ union. We were the ones who threw open Pulse, the students’ festival at AIIMS, to fashion, jam sessions and music. Before that, it was a sporting event. We made it socio-cultural,” he says.

COSMETIC SURGERYSunil Choudhary, 42, Aesthetic and Reconstructive surgeon, Max Speciality Hospital, Delhi
Quite like modern day Dr Frankensteins, attaching a hand and replacing chopped fingers with toes is all in a day’s work for reconstructive surgeons. Some, like Sunil Choudhary, who head the aesthetics and reconstruction at Max Speciality Hospital, start a conversation with, “Today, I attached two toes and one finger in the right hand of a 16-year-old who’d lost his fingers in a farming accident. He’ll be able to write now”. This is followed by an MMS of a surgery to fix a congenital defect in which a child’s skull stops expanding naturally, squeezing the brain and making it bulge out of the forehead. Unlike popular perception, silicone implants and other cosmetic procedures make up less than a third of a cosmetic surgeon’s case load. “A lot of what we do is related to reconstruction after cancer surgeries and accident cases, including burns and acid attacks,” he explains. Choudhary grew up in Delhi, went to school in DPS RK Puram and did his MBBS from Maulana Azad Medical College, after which he joined the training programme of the UK’s National Health Service.

He insists on giving you a business card. “I’m the only one in the world with this name, so people often get it wrong,” says Dr Shahin Nooreyezdan. There is, however, a little boy called Shahin Sharma, who was called Golu before his grateful parents renamed him after the surgeon who reattached his finger. “It was deeply touching, but also strange. I guess now there’s another person in the world with a very unusual name,” he says. Nooreyezdan grew up in Mumbai, where he lived with his parents in a flat above Russi J Manekshaw, the granddaddy of plastic surgery in India. “Each day, I’d walk past his door on my way home from school and pass this display box with before- and after-surgery pictures, which kept changing every week. I was hooked and decided this was what I wanted to do,” says the Delhi-based Nooreyezdan. He moved to London in 1996, where he worked at St Andrew’s Hospital for three years and met his wife Neda, a British citizen. “When we decided to move back and I went to the Indian High Commission for a visa for my wife, the clerk there said, why are you going? You have a great future here!” he laughs. Most of his work in India is reconstruction. “Unlike other surgeons who can walk in to do the critical part of the surgery, I have to be there from the first incision to the final stitch because what I do is for everyone to see,” says Nooreyezdan, who gets women as young as 19 who need reconstruction after breast cancer surgery. The deft fingers that reconstruct tissues and reattach blood vessels 1.2-1.5 mm in diameter also help him pursue his hobby: collecting and repairing antique clocks. Nooreyezdan has a collection of over 125 pendulum clocks from all over the world, including grandfather clocks from the UK, clocks from ships and railway stations. “It started when I was 17, when I noticed an old, broken, clock at an Irani dhaba. I bought it for R170, got it home and fixed it. I still do it, though I have to pay a guy to wind them up in rotation once a week,” he says. He clearly knows how to wind down.

ORTHOPEDIC SURGERY

Dr Vijay C Bose, 44, Head of orthopaedic surgery, Apollo Chennai
He was part of British orthopaedic surgeon Derek McMinn’s crack team that developed the ‘Birmingham Hip’ – a hip implant that allows people to play contact sports and twist without shouting after a hip transplant – in the late ’90s. Yet what gives Dr Vijay Bose the greatest joy is recognition from his peers. “Three weeks ago, a renowned joint replacement surgeon from the US got his son to our centre for surgery. He’s one of the best in the world and could have done it himself, he could have got it done by the best in his own country, but he still came to India. That’s the quality India offers to the world now,” says Bose. Bose, who joined Apollo Hospital in Chennai in 2000 after six years in Birmingham and Liverpool in the UK, now routinely gets so many patients from overseas that he’s became the face of medical tourism in India for 60 Minutes on CBS News. “I did the first implant in Apollo in 2000 and since then, I have demonstrated the technique across 80 hospitals in India,” says Bose, who did his MBBS from Madras Medical College in 1990. Apart from hip replacement, he does knee and shoulder joint reconstructions.

Dr Suraj Guruv, 36, Orthopaedic surgeon, Asian Heart Institute, Mumbai
Dr Suraj Guruv’s last holiday was spent shooting wildlife at Bandhavgarh National Park in Madhya Pradesh, but he did not break any laws. Guruv is an amateur photographer and rarely leaves home without his Nikon Digital SLR. “I’m crazy about wildlife photography,” he says. When he’s not shooting, Guruv is fixing damaged hips and knees using minimally invasive bone-conserving surgeries in India that make it possible for people to run, drive and work just as they did before, after hip or knee replacements. Guruv is a Mumbai boy, who grew up in Prabhadevi, went to a neighbourhood school, did his MBBS at Mumbai’s Topiwala National Medical College and worked in Bombay Hospital before going to train in Singapore General Hospital. “I belong to a family of chartered accountants, my dad is one, so is my older brother. So when dad said try something else, I thought, why not?” says Guruv, who aced his entrance exam. “Even though I don’t invest in the markets, I still follow financial news very closely, perhaps because that’s what I’ve grown up hearing,” he says. He returned to India because he wanted to be part of the boom in medical care that India is witnessing. “We now have medical facilities at par with any other in the world, with better care,” he says.

HEART SURGERY
Dr Raja Joshi, 40 Paediatric cardiac surgeon, Apollo
He’s called the ‘bandana guy’ because he wears a bandana instead of a surgical cap while operating. Apart from his training as a paediatric heart surgeon during a five-year stint at Cleveland Clinic in the US, what defines Raja Joshi is his bandana collection. “You have to strike a chord with the kids you’re treating, and a bandana with Dalmatians on it sure helps to break the ice,” says the Delhi-based Joshi who, at 36, became one of the youngest surgeons in the country to set up a paediatric cardiac surgery unit in a major hospital. “My dad was in the air force, I grew up wanting to be a fighter pilot. It was after my class 10 boards that my dad told me there were other ways to earn a living,” he recalls. The idea of being a heart surgeon for children came a year later, after a Doordarshan show on a hole-in-the-heart being fixed. “It was so dramatic, the lights and the surgeons in scrubs, this child being immersed in ice to bring the body temperature down. Suddenly, that was the only thing I wanted to do,” says Joshi. He’s had no regrets. “It’s one of the few surgeries where the patients outlive the surgeons. You won’t believe the number of birthday invites I get. Anyone can do adult heart surgery, paediatric is what separates the boys from the men,” said Joshi. His wife Reena Joshi, 36, is a paediatric anaesthetist who’s helped him introduce innovations such as letting the mother stay with the child in the operation room till he sleeps. “Taking away a baby from the mother makes anxiety levels shoot up. Keeping them together till the baby is anaesthetised improves surgery outcomes,” says Joshi.

Pranav Kandachar, 37, Paediatric heart surgeon, Asian Heart Institute, Mumbai
Heart surgery is one of the cleanest surgeries there is, it’s like mathematics. The result is directly related to what you do, there are few surprises,” says Pranav Kandachar, the newest heart surgeon to join Asian Heart Institute’s team of surgeons. “Of course, there are some conditions in which you cannot play god, but in most cases, children can lead active, normal lives after surgery,” he says. After doing his MBBS from Bangalore Medical College in 1997, Kandachar worked at Sion in Mumbai, Apollo Chennai and Colombo, did a year long stint in New Zealand, returned to Bangalore to work at Shirdi Sai Baba Charitable Hospital, and joined the Asian Heart Institute, Mumbai, in January this year. “When you’re training, one institute can’t offer you everything. I’ve trained with the best,” he says. Kandachar describes himself as a nature kind of guy, being big time into hydroponics, a scientific method of growing plants in water – without soil – using mineral nutrient solutions. “I have a virtual vegetable garden in my little balcony, where I grow spinach, beans, cauliflower, coriander and mint. I’m planning to grow strawberries next,” he says. He’s also into ornithology and is part of a nature club that goes birdwatching to sanctuaries at least once a month.

Bangalore, July 28, 2010: Fortis Hospitals conducts Asia’s first Custom Fit Knee Replacement Surgery in Bengaluru (formerly Bangalore). 56 and 59-year-old women suffering from degenerative disease of the knee brought to Fortis Hospitals with complications, underwent Asia’s first Custom Fit Knee Replacement Surgery. Patients were discharged within five days of the knee replacement operation. Patients started walking normally within a fortnight, unlike the usual 6-8 weeks required before resuming normal activities in the conventional surgery.

Dr. Sanjay Pai - Lead Orthopedic Surgeon, India

Lead orthopedic surgeon Dr. Sanjay Pai and his team at Fortis Hospitals Bangalore performed this revolutionary surgery by literally remodeling the anatomy of the patient’s knee and recreating or customizing a knee with the right kind of technology and expertise. The new custom fit knee replacement technology designs a perfect instrumentation system that matches the patient’s knee and ensures lesser pain, less tissue damage and faster mobilization.

According to Dr. Pai, “The two operations for knee replacement have been performed for the first time in Asia using the custom fit knee replacement technology. This is indeed a medical breakthrough and likely to revolutionize the way knee replacement surgeries are performed in India. We are glad to be the first adopters of this technology.”

Why Custom-Fit Knee
While conventional knee replacement surgeries retro-fit predetermined sizes of prosthetics on to the patients’ knee, this procedure is very different because it works on the principle that no two patients’ knees are similar. With this technology the patient’s knee is digitally recreated with 3D image mapping after taking into account the bone structure, weight ratios, gender, age and even mechanical alignment. Based on this 3D model the customized knee is created. Something, that just fits them right. This technology ensures far greater accuracy and reduces the operation time by almost 40% and also results in less loss of bone & tissues.

How Custom Fit Knee Works
In short there are 4 steps to building and fitting a Custom-Fit Knee:

Step 1: Understanding your knee
The process starts with a CT Scan of the whole leg from the hips to the ankle which is then used to create an advanced 3D image of the leg structure. The age, weight and gender are also taken into account, creating a complete patient imaging.

Step 2: Processing and planning
With the 3D plan of the leg structure in place, an anatomical model is created to determine the mechanical alignment – the basic philosophy on which the entire process rests. Virtual instrumentation is then done and the surgery is planned accordingly.

Step 3: Recreating the knee
Once the surgery is approved, the Custom Fit instruments are manufactured at state-of-the-art dedicated manufacturing centers. Even the individual patient name and data are etched on each unit to confirm identification during the surgery

Step 4: Fitting the knee
With the Custom Fit instrumentation in place, the knee bone is chiseled to perfection so that the prosthetics fit exactly without any requirement for later corrective surgeries. After a 60 minute surgery, the patient ill have the knee that fits you perfectly.

Benefits of Custom Fit Knee Replacement Surgery

Smaller incision

Less soft tissue damage

Lesser pain

Early and better mobilization

Better and pain free range of motion

Improves alignment and sizing by using computer generated images of the patients anatomy to determine bone cuts and implant positioning preoperatively

Better life span of the processes because of the accurate fit and alignment

Chennai, India: Sixty-five-year-old US citizen Ronald Lemmer’s heart is expected to beat for India after his successful heart transplant operation in Chennai.

He is the first American and the oldest person to undergo a heart transplant in India.

“The US doctors said that my husband would not survive if operated in India. We checked with an Indian doctor who is our friend there. He assured us about the safety and we came to India,” Shelly Lemmer told reporters.

“In the US there is a long waiting list of recipients for heart transplant,” Lemmer said.

The couple came to India in May and Lemmer was admitted to Apollo Hospital.

“We were in discussion with the American couple since March this year. They came here in May and Lemmer was operated upon in July,” senior cardiothoracic surgeon Paul Ramesh said.

According to Ramesh, the Lemmer case was a bit complicated as he had a previous bypass surgery, an angioplasty with coronary stents and a pacemaker.

In the US, Lemmer was told that he had a mortality chance of 80 per cent.

The other challenge was that the transplant was an inter-racial one and the human leucocyte antigen (HLA) has to match.

“The HLA will be an exact match only between identical twins. Between siblings it would slightly differ. The difference will be high between two different races,” Ramesh added.

Fortunately for Lemmer, he was able to get the heart of a 36-year-old man who was declared brain dead after a road accident.

Necessary compatibility tests – height, weight, blood and others – were done and permission from the Transplant Coordination Committee was obtained to carry out the operation, Ramesh said.

Today Lemmer is walking around like a normal person and is planning to return to the US August 10.

“The success of a transplant operation is determined not only by increasing the longevity of the patient but also in improvement in the quality of life he leads post operation,” Ramesh said.

According to him, Lemmer’s quality of life will be better henceforth.

The surgeon said equally interesting are the cases of Kasturirangan, who underwent a heart transplant a year back, and Piyush, who is two and a half years post-transplant and leading normal life.

“For Kasturirangan it is a transgender transplant operation. He now has the heart of a woman,” Ramesh said.

“In India heart transplants are done only in cities like Chennai, Delhi, Hyderabad, Cochin and Bangalore. In the last 15 years, only 100 heart transplants have been done in India of which 10 were done at Apollo Hospital in Chennai,” he said.

Girinath also said that organ transplant operations are subject to various uncertainties and challenges like availability of organ, logistics and coordination with different medical teams – the one that harvests the organ and the other that fixes it in the recipient.

According to Ramesh, heart transplant operations that are not complicated would cost anything between Rs. 800,000 to Rs. 1 million.

An excellent article appeared recently in Dallas News that talked about the health care systems in other Western countries and what America can learn from them to resolve its health care woes. Here is the article for a good read…

Tackling the high cost of health care is politically bruising and difficult work around the world. Among developed countries, only the Norwegians rival our level of spending. The French wrestle with rising costs every year. The Canadians are searching for a better model, and have had their eyes on France. But for all their troubles, the French and the Canadians – two bogeymen in the American reform debate – spend much less and live longer than we Americans.

In the last five years, I’ve spent time reporting on health care in 10 other countries to see what they might offer in the way of suggestions to improve the American way of medicine. No one has a perfect system. No one has a permanent solution. But medical spending can be slowed without sacrificing quality. Some do it with government price controls and government doctors, while some do it with government acting as a referee. Neither approach is fatal to medical quality.

The Swiss, the French and the Canadians all use very different approaches to get at the problem, but they get there. And when all else fails, there’s still medical tourism. You can get heart bypass surgery, with a tour of the Taj Mahal, in India for less than 10 percent of the U.S. cost – plus a year’s supply of pharmaceuticals.

I met Carlo Gislimberti, a New Mexico restaurateur, in New Delhi in 2005 while he was waiting for a coronary bypass at the Escorts Heart Institute and Research Centre. He’d had three heart attacks. He had no health insurance. His Albuquerque hospital wanted $120,000 for the operation.

Escorts did the job for less than $12,000.

“It was an absolutely wonderful experience with wonderful results,” Gislimberti said last week when I called him in Santa Fe.

“There was only one thing – the luxury is not there. But the knowledge, the quality of nursing, it was absolutely beyond belief. … I would still today recommend to all the people in my predicament to go abroad.”

Medical tourism is no longer a quirky answer for the desperate and uninsured. The health-consulting arm of Deloitte estimates 1.6 million Americans will seek medical treatment in another country this year. U.S. health insurers, looking for ways to lower costs, are exploring policies that cover such travel.

Gislimberti, now 64, sold his restaurant and paints for a living. His heart ailments qualified him for disability under Social Security, and last year he was accepted under Medicare. He had a pacemaker installed by his Albuquerque hospital in an operation last May.

One thing he learned: “If you have insurance, this country is the greatest. But it you don’t have insurance, this is a Third World country.”

Another lesson: Price competition is coming. A study by the McKinsey Global Institute consulting group last fall found that Americans pay 50 percent to 60 percent higher charges for pharmaceuticals, health insurance overhead and physician services than anyone else in the world. That could make medical tourism irresistible, and a competitive risk to the U.S. medical establishment.

Switzerland is intriguing because employers have gotten out of the insurance business. The Swiss government mandates personal health insurance. Everyone shops among scores of insurance companies to buy a policy. The insurers must offer everyone a basic policy and can’t exclude anyone. The government offers subsidies to people who can’t afford a policy, and fines people who don’t get one.

Swiss medical fees are set in annual negotiations between health care providers and insurers that must win the approval of the canton parliament. (Insurers and hospital chains do the same thing here, but those negotiations are seldom among equals and don’t have a referee like the canton parliament.)

One result of the Swiss approach is that consumers gravitate toward high-deductible policies – insurance that costs less per month, but takes more out of your wallet when you see a doctor. And because they’re paying for it, the Swiss are more cost-conscious health consumers. The Swiss spend about a third less than Americans for medical care.

France and Canada both have national health insurance. In France, this is like Medicare for all. There’s a gap of 30 percent to 40 percent between what the government insurance covers and what health care costs, so a lively market exists for private, supplemental insurance policies.

Doctors can choose compensation under a government schedule revised every year, or they can charge what they like – and forgo a government pension.

Canadians may, famously, wait for nonurgent treatments and surgeries. But they’re quicker to rally around a public health issue like obesity, because the insurance mechanism is part of the provincial government.

“Our wait lists are coming down, but they’re still substantially more than yours,” said Canadian health economist Steven Lewis. “But your system is twice as expensive. It doesn’t insure 45 million people, it underinsures another 45 million, and overall you have a less healthy population. Is that worth sustaining?”

In the current health care debate in Washington, no one argues that we should throw out the U.S. health care model for an import. There are models closer to home – like Temple’s Scott & White – worth emulating.

But there are plenty of places that spend less for equal or better care. It can be done.

Why Health Care Costs Keep Rising – Analysis and Solutions

It’s no secret that the health care in the United States is expensive. But have you wondered why this is the case? Here’s an excellent analysis of the situation that we came across with proposed solutions of what can be done to cut down prices for the health care consumer – something which we feel you will find useful too. So, read on…

Summary

When economist Charles Wheelan published an analysis titled “The Top 10 Reasons for Soaring Health-Care Costs,” it was refreshing to read about the problem from an economics point of view. What Wheelan did not cover, however, was what we can do to address the issues that continue to cause health care costs to spiral out of control. What follows is a point-by-point look at Wheelan’s top 10 reasons followed by a discussion of what we are doing—or could do—to control costs better.

Analysis

Reason 1.
Nobody Shops for Value
Wheelan argues that when it comes to health care, everyone wants and expects the best. “There’s no medical equivalent of Wal-Mart,” he writes. “Everyone wants Neiman Marcus.”Solution: Some health plans are addressing this issue by discouraging patients from using expensive facilities for common problems, such as a sore throat, through co-pay incentives and member education. Not only are patients encouraged to find a less expensive facility, they also are encouraged to ask the doctor to write generic prescriptions.
The question is, how do patients know which facilities offer reasonable prices and quality medical care? It will take greater health care cost and quality transparency—and better consumer education—to get health care shoppers to the same level of sophistication they use in buying other high-end goods (e.g., cars), but progress is being made. A number of health plans now offer cost information on various treatment options, and web sites such as HealthGrades offer quality information on doctors, making it possible for people to shop for health care online.

Reason 2.
Medical Innovations Are Usually More Expensive
The basis of medical progress is learning to do new things, no matter the cost. In the case of pharmaceuticals, the system has been designed so new drugs are expensive. Breakthrough medications receive patent protection, and the better the drug, the more its producer can charge. High prices yield high profits, which creates an incentive to develop the next generation of drugs.Solution:Although we, as a society, have agreed to pay more for innovative medications and medical devices, especially those that introduce new cures, we have not agreed on who is going to pay for them. Part of the solution lies in the expansion of employer-sponsored wellness and health promotion programs that focus on keeping healthy people healthy and helping those who are sick to better manage their illnesses by steering them toward proven treatments. Value-based benefit plan design tries to achieve this by removing barriers that may be barring patient access to the most effective medications.
Furthermore, not all innovations (which include diagnostic tests, imaging tests, medications and medical devices) should be treated equally. While some add value, some do not. One solution is to use a creative plan design that identifies the most effective innovations and reimburses them with a premium.

Reason 3.
Some Health Care Is a ‘Luxury Good’
Used as a technical economic term, a “luxury good” is something wealthy people demand in disproportionately greater amounts than less wealthy people do. Richer societies and richer people within a society have higher expectations for health care. They expect medical fixes—such as hip replacements, stomach stapling and Lasik eye surgery—for problems that people with lower expectations will just tolerate.Solution: While it’s easy to poke fun at medical tourism, it may well emerge as one of the solutions to this problem. Medical tourism generally involves traveling to another country for non-emergency care, including knee replacements, shoulder surgery and even heart bypasses. A knee or hip replacement that may have a retail price of $65,000 to $80,000 in the United States costs between $8,000 and $10,000 in India. The Deloitte Center for Health Solutions predicts that the number of Americans using medical tourism could jump tenfold over the next decade, to nearly 16 million a year.

Reason 4.
We Don’t Pay for What We Consume
Health care is unique in that neither the service provider nor the patient gets the bill, especially when insurance out-of-pocket maximum provisions are reached. The patient who is directly involved in the transaction has little incentive to control costs when out-of-pocket costs are removed. When insurance companies try to do so, it can lead to arbitrary limits on care, time-consuming hurdles for more expensive procedures and additional bureaucracy for doctors. Even then, it’s easy to game the system.Solution:One possible solution is moving away from fee-for-service provider reimbursement and returning to a staff-model health maintenance organization (HMO), where providers employed by the health plans are charged with offering patients the most cost-efficient care without compromising quality. Two studies have found that this model works quite well. A 2002 paper in the British Medical Journal (BMJ), “Getting More for Their Dollar: A Comparison of the NHS with California’s Kaiser Permanente,” compared HMO provider Kaiser and Britain’s National Health System (NHS), concluding that Kaiser achieved better outcomes than the NHS for similar inputs. And a 2003 study in the BMJ, “Hospital Bed Utilization in the English NHS, Kaiser Permanente, and the US Medicare Program: Analysis of Routine Data,” which reported on hospital stay lengths, produced similar conclusions.
Over the past few years, several large employers have brought care delivery on-site in the form of clinics, using the same premise as the staff-model HMO. Revisiting global provider payments per admission or bundled payments for treating all the medical needs of specific patients with chronic disease might return to favor.

Reason 5.
Baumol’s ‘Disease’
Not a disease, but an important insight by economist William Baumol on what afflicts certain sectors of the economy, such as health care and higher education. He found that as societies become richer, labor-intensive endeavors, such as health care, become increasingly expensive relative to goods and services that can be produced using less labor. As long as the doctor-patient relationship remains relatively unchanged, health care costs will rise faster than prices in general.Solution: Because there are no economies of scale, a surgeon cannot perform more than X number of surgeries and a primary care physician (PCP) cannot see more than X number of patients in a day (although we have seen the latter rise dramatically in the past two decades). For them to keep up with others, who are earning more money in less time because of technological advances, they have to increase their unit cost.
Pay-for-performance-type programs can help identify providers who are practicing quality medicine in the most judicious and cost-effective way. Once such high-quality and cost-efficient providers are identified, patients need to be directed to them. Specialized cancer and transplant centers are a good example of where upfront costs are relatively high but long-term outcomes are better and repeat illnesses are fewer.

Reasons 6 & 7.
Living Longer and Living an Unhealthy Lifestyle
Not only are people living longer (which in itself increases health care costs), but too many people are living unhealthy lives. This includes smoking, eating fast food and driving instead of walking, to name but a few.Solution: While we can’t change the fact that people are living longer (nor would we want to), we can help them live healthier lives. The latest shift in health care is to focus on keeping the healthy healthy and to stop diseases from progressing from bad to worse. This can be achieved through wellness and health promotions, health education and coaching, communicating information on healthy lifestyle choices, and making sure those who need care have access to the right care at the right time to maximize clinical and economic value. People who are at risk or at high risk can be identified via health risk appraisals and sophisticated technology and tools, such as predictive modeling, which uses claims data to identify risk.

Reason 8.
The Uninsured
The uninsured end up costing the system a great deal of money. In a family that is uninsured, a child with a high fever and a bad cough will probably be treated in a hospital emergency room—a very expensive use of a trauma center and its highly trained staff. Or the child might not be treated at all until five years later when he or she develops asthma or another chronic condition that could have been managed far less expensively with better primary care.Solution: This is a problem that needs government intervention. Although President Barack Obama has pledged to intervene, his health care program has yet to be addressed—specifically, how his programs will cover all Americans in the most cost-effective delivery setting.
One solution that plan sponsors can undertake in the meantime involves helping their pre-age-65 retirees with health insurance. They can take advantage of the innovative solutions that some health plans now offer—allowing employees to prefund premiums that contribute toward buying coverage after retirement but before they are eligible for Medicare.

Reason 9.
The High Cost of End-of-Life Care
Even people who are treated successfully for heart disease or cancer eventually die. Any medical success begets additional medical expense, which is especially true for end-of-life care. The last six months of life are typically the most expensive period of a person’s life.
The escalating cost of treating illness at the end of life raises moral and politically charged issues that are difficult to address: What is the actual value of using expensive treatments on people whose life expectancy is drastically limited, even with the treatment? While other countries have begun to base coverage decisions, in part, on how many years of quality life a treatment is expected to produce—for example, the clinical guidelines created by the U.K.’s National Institute for Clinical Excellence—this issue still seems to be taboo in the United States. Most of these costs are incurred by Medicare and Medicaid.Solution: We need to be better at considering quality of life in decisions about treatments and services for chronically ill elderly patients. It has been suggested that Medicare and Medicaid could form a governing body of clinicians that can make and authorize these difficult decisions.
In addition, society needs to make better use of hospice care. Employers and plan sponsors should educate their beneficiaries about hospices and the situations in which they are the best option.

Reason 10.
Malpractice Suits
Malpractice is more of a legal problem than an economic one because doctors tend to practice “defensive medicine” out of fear of being sued. Seeking to avoid lawsuits, they have an incentive to over-treat all kinds of maladies. Research shows that physicians in countries such as the United States—where the risk of malpractice suits is high—tend to order more investigative tests than those in countries with less risk, such as the U.K. (See, for example, the New York Times article “Why Does U.S. Health Care Cost So Much?”)Solution: Washington Post columnist George F. Will has proposed an appropriate solution to this complex issue. We have juries of people who have no knowledge of the complexities of medicine handling decisions on whether a patient’s death resulted from negligence on the part of the physician or whether the doctor did everything in his or her power to save the patient. Instead, the state judicial system could create a panel of highly qualified judges with access to independent clinicians who are familiar with the highly complicated nature of such cases and remove some of the emotional overreactions by juries that result in disproportional monetary awards that should be reserved for cases of gross negligence. This will help physicians use sound clinical judgment instead of practicing defensive medicine.

One More Reason: Lack of Access to Complete Information
Doctors collect and create a lot of information—everything from notes to diagnosis codes. The insurance companies add another level of data. While much of this information could be used to improve treatment and reduce costs, no one is in a position to see it all. A doctor who prescribes a treatment doesn’t know what it costs or whether the patient’s insurance covers it. An insurance company that questions a doctor about a treatment might never receive all of the information it needs. When a patient switches providers, it can result in duplicate tests and services and potentially dangerous treatments. All this creates tremendous administrative waste and resource consumption for providers and payers.Solution: Electronic medical records (EMR) and health information exchange (HIE) are two steps in the right direction toward health care interoperability (the ability of different information technology systems and software applications to communicate; to exchange data accurately, effectively and consistently; and to use the information that has been exchanged). Developing standards for EMR interoperability is at the forefront of the president’s health care agenda. Many physicians have computerized practice management systems that can be used in conjunction with HIE, allowing them to share patient information (e.g.,lab results, public health reporting), which is necessary for timely, patient-centered and portable care.
Similar movement is happening on the payer side, which is attempting to collect more information from providers as well as consumers. They are making decision-support tools available to their beneficiaries, to help them navigate the system. Some payers are also adopting personal health records, which members can take with them if they change insurance providers.
Another step in the right direction is the patient-centric medical home model, in which a patient’s physician knows everything there is to know about that person’s health care. This requires comprehensive patient management software that allows the physician to coordinate all the care the patient needs.

Conclusion
The good news is, there are potential solutions to most of the reasons health care is so expensive. The real challenge is in getting the different stakeholders to work together to solve this monumental problem.

Healthbase collaborates with WellPoint to bring affordable healthcare benefits to Americans through an international medical tourism pilot program. Members will now have more choices regarding where to receive care and a greater involvement in the care they receive

BOSTON, Jan. 5 /PRNewswire/ — Healthbase Online Inc., a Boston-based award-winning medical tourism facilitator, has collaborated on a pilot basis with WellPoint, Inc., an Indianapolis-based health benefits company to provide global health care coverage to members of WellPoint’s affiliated health plan in Wisconsin. Healthbase will handle all the medical travel logistics and arrangements for WellPoint members.

According to Saroja Mohanasundaram, CEO of Healthbase (http://www.healthbase.com), “Healthbase is committed to providing high quality medical travel services at affordable cost. Healthbase will assist WellPoint members with coordination of the trip, medical appointment scheduling, digital medical records transfer, and concierge travel service.”

Under this program, effective from January 2009, members who travel for certain non-emergency elective procedures like joint replacement and spinal fusion, will have access to Joint Commission International accredited healthcare providers in India. This will result to lower out-of-pocket costs for members translating into thousands of dollars in total savings. A hip replacement surgery, for example, costing over $60,000 in the US, costs less than $8,000 at an accredited hospital in India.

“We are pleased to work collectively with Healthbase to deliver an international medical tourism pilot product to our clients who are interested in exploring a medical tourism solution,” said Dr. Razia Hashmi, vice president and medical director for WellPoint’s national accounts division. “Medical tourism is a promising option for improving access to affordable, quality health care. Working with Healthbase, our case managers will coordinate all steps of the medical tourism process for members interested in receiving care overseas.”

WellPoint, Inc. is the largest health benefits company in terms of medical membership in the United States. WellPoint is an independent licensee of the Blue Cross and Blue Shield Association and serves its members as the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as the Blue Cross Blue Shield licensee in 10 New York City metropolitan and surrounding counties and as the Blue Cross or Blue Cross Blue Shield licensee in selected upstate counties only), Ohio, Virginia (excluding the northern Virginia suburbs of Washington, D.C.), Wisconsin; and through UniCare. Additional information about WellPoint is available at http://www.wellpoint.com.

The health insurer Wellpoint is testing a new program that gives covered patients the option of going to India for elective surgery, with no out-of-pocket medical costs and free travel for both the patient and a companion.

The program is being tested at Serigraph, a printing company in Wisconsin whose managers have been looking for ways to curb rising health care costs, said Dr. Razia Hashmi, chief medical officer for national accounts for Anthem Blue Cross and Blue Shield, which is affiliated with Wellpoint.

“This is a first for us,” Dr. Hashmi said. “We will be monitoring every aspect of this very closely, to make sure everyone is satisfied and there are good clinical outcomes.”

By the year 2010, more than 6 million Americans annually will be seeking medical treatment abroad , according to the Deloitte Center for Health Solutions, a consultancy. The potential savings are significant. Knee surgery that costs $70,000 to $80,000 in the United States can be performed in India for $8,000 to $10,000, including follow-up care and rehabilitation, Dr. Hashmi said. Similar savings could be achieved for such common procedures as hip replacements and spine surgery .

If other insurers follow Wellpoint, Dr. Hashmi said, the trend ultimately may pressure on United States hospitals to be more competitive in their pricing.

Critics say that’s unlikely.

“There have been some reports of hospitals that have been willing to match the prices, but I don’t know how they’re doing that,” said Howard Berliner, a professor of health policy and management at State University of New York Downstate Medical Center in Brooklyn. “The reality is there’s just no way that most hospitals can respond to this. It’s just like any service that’s outsourced – the price is so cheap abroad that there isn’t much an American company can do about it.”

At the same time, he said, the program could potentially siphon off the healthiest, most profitable patients from a local hospital.

Dr. Hashmi predicted that the program would appeal primarily to people who have traveled abroad. Many employees of Serigraph, which has offices in India, are familiar with the country.

“The quality is comparable” to care provided in the United States, Dr. Hashmi said. All the physicians speak English, and patients can share their medical records and consult with a surgeon in India before making the trip, she said.

The pilot program arranges for patients to be picked up at the airport and provides special meals to prevent food-borne illnesses. The program complies with the American Medical Association guidelines on medical tourism and uses hospitals accredited by the Joint Commission International.

Dr. Hashmi said it had actually been easier to evaluate the quality of medical care abroad than in the United States. “There is a lot more willingness to share data about complication rates, the total number of procedures and the outcomes,” Dr. Hashmi said. “We’re able to get detail per hospital and per physician.”

In addition to saving out-of-pocket costs for surgery for patients, the program could potentially help keep insurance premiums affordable, Dr. Hashmi said.